providers

Migraine Anxiety Related Dizziness (MARD)

Published on: February 19, 2013

Described by Furman et al (2005) we see this condition in an increasing number of non-labyrinthine cases of internalized dizziness with heightened motion and visual disturbance.  In fact, at AIB, in just the past 10 days we have seen a 49 year old female speech pathologist and a 33 year old female computer programmer. All radiographic studies and medical-lab work is negative. There is no precedent history of a vestibular event (vertigo lasting 30 minutes to hours) or any auditory symptoms.  Oftentimes, they had been sent for vestibular rehabilitation (VRT), but after several weeks when no progress is made they are sent to us for evaluation and consultation. This is also the danger of referring to therapy without a comprehensive evaluation. There are no focal neurological symptoms and no associated headache. Yet, it is seen exclusively in pre-menopausal females with life-long history of migraine. The patient reports that they have increasing levels of stress at home or at work, sometimes both. The individual is usually well-educated with a type A personality. It is common for them to have a history of anxiety and panic attacks, histrionic, and obsessive compulsive personality traits. Their vestibular tests are almost always completely unremarkable and well within normal parameters. The exception is the possible caloric weakness, which is however not uncommon in migraine patients and may have no relationship to their current symptoms. That is why tests of function i.e. head thrust, dynamic visual acuity, or CTSIB which have high-sensitivity to non-compensated vestibulopathy should be included in the examination. If they do have a non compensated vestibular condition secondary to a vestibular event, then by all means VRT is the right way to proceed.

Good news, with proper counseling, medical, pharmacological and behavioral management these patients do improve. The goal is to be sure the patient has a thorough medical examination, a vestibular examination with tests of function and avoid VRT without a diagnosis. The best way to help this group of patients is to get them on the right continuum of care and not to assume that VRT will address the symptoms.

Recent Posts

Comparison between Epley and Gans Repositioning Maneuvers for Posterior Canal BPPV: A Randomized Controlled Trial

Published on: March 26, 2024

Annals of Indian Academy of Neurology | Volume 26 – Issue 4 – July-August 2023 Benign paroxysmal positional vertigo (BPPV) is one of the commonly occurring causes of vertigo. BPPV […]

Read more

How to evaluate and treat the dizzy patient: non-medical diagnosis-based strategies

Published on: February 16, 2024

ENT & Audiology News | Balance & Vestibular Disorders 2024 It is estimated that dizziness, vertigo and falls are the third most common complaints heard by physicians from all age […]

Read more

The cost of untreated vestibular conditions: the role of otolaryngology & rehabilitation

Published on: February 15, 2024

Journal of Otolaryngology-ENT Research | Volume 16 Issue 1 – 2024 It is estimated that dizziness, vertigo, and falls are the third most common complaints heard by physicians from all […]

Read more

Understanding Mal de Debarquement syndrome (MdDS), persistent postural perceptual dizziness (3PD) and somatoform disorders: and the role of vestibular rehabilitation therapy (VRT)

Published on: January 3, 2024

Volume 16 Issue 1 – 2024 Richard E Gans, Kimberly Rutherford, Allisson D’Alessandro American Institute of Balance, USA Correspondence: Richard E Gans, Founder and Executive Director of the American Institute […]

Read more